Medical Management Of Anorexia Nervosa And Bulimia Nervosa - Comprehensive Medical Information About Bulimima

Written by HealthyPlace.com Staff Writer

One other important condition with regard to the esophagus is Boerhaave's syndrome, which refers to a traumatic rupture of the esophagus due to forceful vomiting. It is a true medical emergency. Patients with this condition complain of the acute onset of severe chest pain that is worsened by yawning, breathing, and swallowing. If this condition is suspected, prompt referral to an emergency room is indicated.

Lastly, vomiting causes two main electrolyte disorders: hypo-kalemia (low potassium) and alkalosis (high blood alkaline level). Either of these, if severe enough, can result in serious cardiac arrhythmia, seizures, and muscle spasms. It does not suffice to place these patients on supplemental potassium, because the body cannot absorb the potassium. The beneficial effects of supplemental potassium are nullified unless there is restoration of the volume status either with intravenous saline or oral rehydration solutions such as Pedialite or Gatorade. One final point about self-induced vomiting: some bulimics use ipecac to induce vomiting. This is dangerous because it is toxic to the heart. Because of ipecac's long elimination time, repeated ingestion can result in potentially fatal cumulative doses. Heart failure and arrhythmia can result.

LAXATIVE ABUSE

If the mode of purging is through laxative abuse, there are also potential problems with potassium and acid-base aberrations. It is worth telling patients that laxatives are a very ineffective method to induce weight loss because caloric absorption occurs in the small bowel and laxatives affect the large bowel by promoting the loss of large volumes of watery diarrhea and electrolyte depletion.

The main body system affected by laxatives is the colorectal area. This information refers strictly to stimulant laxatives that contain senna, cascara, or phenolphthalein and directly stimulate colonic activity. These types of laxatives, if used in excess, damage the colonic neurons that normally control gut motility and contractions. The result is an inert, noncontractile tube referred to as the "cathartic colon syndrome." This causes significant problems with fecal retention, constipation, and abdominal discomfort. Loss of colonic function can become so severe that a colectomy (surgery) is needed to treat intractable constipation.

It is crucial to identify laxative abusers early in the course of treatment, before permanent colonic damage has occurred, so that they can be encouraged to seek the assistance of a physician who is adept at withdrawing patients from stimulant laxatives. Laxative withdrawal can be an extremely difficult situation, which is made worse by fluid retention, bloating, and swelling. The mainstays of treatment involve educating patients that it may take weeks to accomplish restoration of normal bowel habits. Patients need to be advised about the importance of ample fluid intake, a high-fiber diet, and judicious amounts of exercise. If constipation persists, a glycerin suppository or a nonstimulating osmotic laxative (works by shifting fluids), such as lactulose, may be useful. Most patients are successfully detoxed with this type of program, but patience is necessary to endure the transient bloating that will resolve in one to two weeks with salt restriction and leg elevation. Progressive abdominal pain, constipation, or distention warrants an abdominal X ray and further evaluation.

DIURETICS

Another mode of purging that can produce medical problems is the abuse of diuretics. This mode is infrequently utilized except by medical personnel who may have access to these medications, although they are also available in over-the-counter preparations containing pamabrom, caffeine, or ammonium chloride. The main complication associated with diuretic abuse is fluid and electrolyte imbalance. In fact, the electrolyte pattern is basically the same as that seen with self-induced vomiting, which is potentially dangerous due to heart problems caused by low potassium levels.

There is also a reflexive development of lower leg edema (swelling) with abrupt cessation of diuretic abuse. Generally the edema can be controlled and treated with salt restriction and leg elevation. It is worthwhile to give a brief educational talk to patients with edema explaining that the condition is self-limited and caused by a reaction from the body which diuretics promote, albeit transiently.

DIET PILLS/APPETITE SUPPRESSANTS

Another method used to avoid weight gain and/or promote weight loss is the use of diet pills. Diet pills are not actually considered a form of purging but are used as a compensatory reaction to binge eating in the category of bulimia nervosa known as "nonpurging type." Most diet pills stimulate the sympathetic nervous system and are amphetamine-type derivatives. The adverse effects of diet pills include hypertension (high blood pressure), palpitations, seizures, and anxiety attacks. There is no long-term dependence syndrome associated with the usage of diet pills, and abrupt cessation is medically safe.

Individuals suffering from anorexia nervosa or bulimia nervosa may be troubled with a myriad of medical complications. However, with proper identification and an effective and safe treatment plan, most of these are reversible. Medical management may thus be the building block for a successful psychiatric treatment program.